Your intake | Coming Home

01 / YOUR INTAKE

A little about you

Let’s start with the practical details.

Fields marked * are required.

First name

Family name

Date of birth

Country of residence

Place of residence

Phone number

Emergency contact phone number

Email address

How did you find us?

02 / YOUR INTAKE

Your journey

Share what brings you here, in your own words.

What would you like to register for?

Individual retreatGroup ceremony / retreat, specify date below

If group ceremony / retreat, please specify which date and/or plant medicine

Have you had experience with plant medicines or other psychedelics (Ayahuasca, San Pedro/peyote, magic mushrooms/truffles, bufo, LSD, …)?

NoYes

If yes, which plant medicines/psychedelics, how long ago, and what were your experiences?

Can you share what motivates you to participate in this day ceremony, retreat, or individual session? Do you have a specific intention?

What are your experiences in the field of personal development? For example: therapy, courses/trainings, retreats, meditation/mindfulness, breathwork/bodywork, …

03 / YOUR INTAKE

Your health

Tell us about your physical and emotional wellbeing.

04 / YOUR INTAKE

Medication & supplements

Help the team understand your current situation.

05 / YOUR INTAKE

What would support you?

You may prefer to discuss personal experiences in a conversation.

As far as you know, can you share something about how your birth took place?

Have you experienced traumatic events in your life that have not yet been mentioned in this intake? This may also include the death of loved ones.

Are there any particular physical or emotional matters important for us to know, so that we can best support you during your journey?

Is there anything else you would like to add?

ONE LAST MOMENT

Take a look.
Then let it go.

Review what you’ve shared before sending it to the Coming Home team.

Submitted answers are available to authorised Coming Home team members. Your answers stay on this page until you send them; they are not saved in browser storage.

I hereby declare that I have answered all questions truthfully.

I accept the general terms and conditions of Coming Home.